A meniscal tear is one of the most common knee injuries and occurs most often in athletes. The meniscus is a circular piece of cartilage with blood supply coming from the outer rim. In order for the meniscus to heal, the tear must be near the outer edge in an area of good blood supply. If the tear is in the central portion, then it will not heal even with surgery, and will need to be removed during the procedure.
Meniscal repair consists of either using arthroscopically placed tacks or suturing the torn edges. Both procedures reapproximate the torn edges of the meniscus, allowing them to heal in the proper position. When combined with rehabilitation after surgery, patients can then successfully heal. However, meniscal repair has a 20 to 40% failure rate. If failure occurs, a second surgery may be necessary to remove the torn meniscus.
Who is a candidate?
Candidates for meniscal repair are young, have tears in their meniscus in a region with significant blood flow (thus facilitating healing), and suffer so-called “mechanical symptoms,” such as:
- Locking of the knee (inability to bend)
- Inability to fully straighten the knee
- A popping or clicking sound in the knee joint
Who is not a candidate?
Removal of the meniscus is a more likely outcome for older patients (the vast majority of patients), whose tears occur in the central portion of the meniscus and thus are unlikely to heal, even with surgery.
Like other surgeries, meniscal repair requires certain general surgery procedures such as preoperative blood testing, and cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before the surgery.
Immediately after meniscal repair, you will be able to walk with crutches. The majority of patients return home on the day of surgery. You will be given pain medication and should not remove the initial dressing on the wound until you receive physical therapy. Keep the knee elevated when resting and lying down to reduce swelling, and walk with crutches to avoid unnecessary stress on the knee.
With two weeks of frequent physical therapy and appropriate treatment of the knee, patients will be able to return to normal daily activities. Patients may continue a physical therapy regimen for up to 6 weeks post-surgery, and may need to wear a knee brace and crutches for normal activity.
As with any surgery, there is a risk of complications related to infection or adverse reactions to anesthesia. Other known complications include injury to nerves and blood vessels, fracture, weakness, stiffness or instability of the joint, inability to repair the meniscus, repeated rupture of the meniscus, or the need for additional surgery.
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